The President's veto was overriden by both Houses on 07.15.08.
The Legislation:
The Medicare Improvements for Patients and Providers Act of 2008 temporarily blocks a scheduled 10% cut in payments to physicians from Medicare, the federal government’s health insurance program for Americans ages 65 and older. Instead, the bill grants a 1.1% raise to the physicians for 2009. The legislation provides incentives to doctors for the use of electronic prescriptions and for reporting on quality of care. The Act extends through 2009 the Qualifying Individual Program that pays the Medicare premiums of low-income beneficiaries. The legislation also increases the amount of assets that applicants are able possess and still qualify for the Medicare Savings Program, which helps low-income beneficiaries pay the costs of Medicare benefits. The bill expands coverage of mental health services and authorizes the Secretary of Health and Human Services to cover new preventive services.
To fund the payment increase for doctors and the extension of assistance programs for low-income individuals, the Medicare Improvements for Patients and Providers Act cuts some funding from Medicare Advantage, a program of private health plans that receive payments from Medicare. Additionally, the legislation prohibits certain sales and marketing activities of Medicare Advantage plans and prescription drug plans, such as door-to-door sales and cold calling.
Finally, the Medicare Improvements for Patients and Providers Act delays the full implementation of programs that allow for competitive bidding on medical equipment. The government will continue to set the price of such goods as wheelchairs and hospital beds.
The Middle-Class Position:
The Middle Class Supports. Skyrocketing health care costs are increasingly burdening the middle class: 47 million Americans lacked health insurance in 2006, an increase of 2.2 million from 2005. According to the Kaiser Family Foundation, health care premiums increased 78% between 2002 and 2007, while wages grew only 19%. Medicare has shielded elderly Americans, who spend more on health care than the non-elderly, from these increasing health care costs, helping them maintain a middle-class standard of living. The scheduled payment cut for doctors offering Medicare services risked forcing many doctors to leave Medicare. Indeed, the American Medical Association reports that 60% of physicians say the cut would force them to limit the number of new Medicare patients they could treat. Stopping the scheduled payment cuts encourages that these doctors continue to accept Medicare beneficiaries.
Further, the legislation funds these cuts by reducing payments to a private Medicare program – Medicare Advantage – that inflates the costs to middle-class taxpayers. Indeed, it is estimated that private Medicare plans are paid 13% more than traditional Medicare plans would be to cover the same beneficiaries. Not only is the Medicare Advantage plan more expensive for the public than traditional Medicare, but it also undermines the principle of universal health insurance for the elderly. By reducing payments to private plans, this legislation begins to move Medicare back to its original purpose to provide public health coverage to elderly Americans to ensure their access to affordable preventive care, hospital care, and prescription medication.
From the Experts:
“The confusing structure of the [private fee-for-service] plan model, the commission structures that pay agents more money to enroll beneficiaries in [Medicare Advantage] products, and the lack of adequate oversight and training of agents by plans offering [private fee-for-service] products has led to a storm of marketing abuse over the last year and a half…In order to ensure that Medicare beneficiaries are able to access timely and quality health care as well as make informed decisions about how they wish to access their benefits through the Medicare program, Congress and [the Centers for Medicare and Medicaid Services] must: 1) act to protect Medicare beneficiaries from abusive practices relating to the sale of [private fee-for-service] plans; and 2) assess the overall suitability of the [private fee-for-service] plan model in relation to enrollees’ ability to access benefits.” – David A. Lipschutz, California Health Advocates, 5/22/2007
“This bill would allow people in Medicare to maintain access to their doctors, improve benefits for low-income, prevention, and mental health programs, and boost quality through national e-prescribing.” – Bill Novelli, Chief Executive Officer, AARP, 7/9/2008
Beyond this Bill:
The Medicare Improvements for Patients and Providers Act achieves modest gains in ensuring the program’s welfare, but additional steps to increase participation in low-income Medicare programs and to reduce overpayments to Medicare Advantage programs are necessary. Indeed, as the cost of health care and the ranks of the uninsured increase, Congress must set its sights on comprehensive health care reform that ensures access to affordable, high quality health insurance for all Americans.
Delaying the implementation of competitive bidding for medical equipment is no more than capitulation to medical suppliers, which benefit from the inflated prices mandated by the government. According to the government’s accounting body, the Center for Medicare and Medicaid Services estimates that its competitive bidding program would result in payment savings of 26%. Congress should immediately allow implementation of the competitive bidding program.
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